Interaction between food systems and health

Impact of functional food systems on health outcomes

• Well-functioning food systems – understood as food systems with healthy sustainable diets being accessible and demanded – have multiple benefits for human health. Healthy sustainable diets can be defined as dietary patterns that promote all dimensions of individuals’ health and wellbeing; have low environmental pressure and impact; are accessible, affordable, safe and equitable; and are culturally acceptable.¹
  • A diet with sufficient macronutrients provides the energy to perform adequate body functions and allows to be physically active.
  • A healthy diet contains all the necessary macro- and micronutrients to ensure a strong immune system which is needed to be resilient to diseases. This includes both communicable and non-communicable diseases.
  • Consuming a healthy diet is crucial for human growth and cognitive growth. If provided with the necessary and sufficient macro- and micronutrients human bones and organs will grow properly allowing all organs to fulfil their function. Furthermore, the brain will develop properly allowing children to learn and to make full use of their cognitive potential. In addition, sub-optimal growth is often linked to life-long susceptibility to illnesses leading to lower economic productivity through lowered labour productivity or absenteeism from work. Consequences of impaired cognitive development include delayed school-attendance and reduced attainment as well as lost employment and socialisation opportunities throughout life. Consuming a healthy diet helps to avoid those consequences. Ultimately, the whole society will benefit from it because the utilisation of the full cognitive potential is a prerequisite for innovation.
  • The consumption of healthy sustainable diets is important for maintaining mental health. In the last years a growing body of evidence has highlighted the impact of such unhealthy diets on mental health potentially leading to an increased prevalence of mental disorders such as anxiety. For instance, a correlation between a diet high in refined sugars and impaired brain function has been documented potentially even leading to a worsening of symptoms of mood disorders, such as depression.²
• The consumption of healthy sustainable diets reduces public health costs and the economic costs of treating diseases and illnesses. The cost of malnutrition in terms of healthcare expenditures is actually paid twice - private individual costs paid by the patient or their family, and public costs relating to government or other institutional costs. Higher costs of medical care are linked to malnutrition as a result of a greater likelihood of hospital admission due to disease severity, longer hospital stays, increased hospital readmissions, higher long-term nursing care requirements, lower effectiveness of prescribed medicines, and sometimes a higher mortality risk. For the public sector the costs are enormous. For instance, it is estimated that in the European Union (EU) costs from disease-related malnutrition amount up to €120 billion per year.³

• [1] FAO 2019, Sustainable healthy diets. Guiding principles
• [2] Nutritional psychiatry: Your brain on food - Harvard Health
• [3] Glopan, 2016. The Cost of Malnutrition.

Impact of good human health on food systems

• If people are occupational healthy referring to the workers well-being and supportive working conditions, they will be able to produce food on the field ensuring availability of nutritious food items. It is important to keep mind that most of global agricultural production is relying on manual labour. In addition, sufficient labour force will be available allowing food to be processed, traded, and sold to consumers. A functional health system is ensuring occupational health by allowing affordable access to services for prevention and treatment and to a caring environment for all generations.
• In addition, being able to produce nutritious food for yourself is an important safety net in times of prices hikes and/or market disruptions. Therefore, it also contributes to household resilience in times of economic and political shocks affecting food economies.

Impact of malfunctioning food systems on human health

• Malfunctioning food systems - understood as food systems with healthy sustainable diets being not accessible and/or not demanded – significantly negatively human health and well-being. The outcomes can be summarised along five impact pathways:
  • Pathway 1: Unhealthy diets and food insecurity
  • Pathway 2: Zoonotic pathogens and antimicrobial resistance
  • Pathway 3: Unsafe and adulterated food
  • Pathway 4: Environmental contamination and degradation
  • Pathway 5: Occupational hazards

The pathways are illustrated below and will be further described in this chapter.

• Pathway 1: Food Insecurity

  Food insecurity understood as the lack of access to sufficient, safe, and nutritious food constitutes a major impact pathway for negative health outcomes. It poses a significant risk of malnutrition including both undernutrition and micronutrient deficiencies due to the insufficient intake of micro- and macronutrients. Expressed in anthropometric terms consequences include stunting (low height for age), wasting (low weight for height) and underweight (low weight for age). The costs of malnutrition are enormous. It is estimated that the total costs of undernutrition amount to 1-2 trillion US$ and 45% of all preventable dea th of children relate to undernutrition therefore directly contributing to increased mortality.¹ Stunting within the window of opportunity (the first 1000 days after conception) leads to irreversible life-long damage such as impaired cognitive growth. Avoiding malnutrition in early life stages is crucial because malnutrition is inter-generational. Often experiences of malnutrition are passed on to following generations. For instance, studies have shown that malnourished women are at a higher risk of having malnourished children than healthy women.

  [1] Glopan, 2016. The Cost of Malnutrition.

• Pathway 2: Zoonotic pathogens and antimicrobial resistance

  The rise of antimicrobial resistances (AMR) and the spread of zoonotic diseases has contributed to the rise of non-communicable and communicable diseases. Non-communicable diseases (NCDs) are of particular importance in low-income countries. According to the WHO of all NCD deaths, 73% are in low- and middle-income countries.¹ In 2010 direct costs of overweight and obesity-related NCDs were estimated to be $1.4 trillion excluding additional costs are borne by families such as higher medical bills, lost income due to illness, reduced school performance and later earnings due to cognitive impairment, funeral bills². Furthermore, AMR reduces the effectiveness of antibiotics affecting a key treatment pathway for bacterial infections and exposing humans to wide-ranging health risks.

  [1] WHO, Noncommunicable diseases (Stand 24.2.205).
  [2] Glopan, 2016. The Cost of Malnutrition.

• Pathway 3: Food Safety

  Food Safety is an essential element of food environments and directly linked to negative health outcomes. Unsafe food includes food being contaminated, improperly stored, unhygienically handled and transported at the wrong temperature. If consumed they may lead to foodborne diseases caused by respective agents such as bacteria, viruses, chemical agents, toxins and parasites with severe health consequences for the individual and the society. A WHO report published in 2015 estimated that food borne illnesses as a result of the consumption of unsafe food caused 600 million illnesses yearly, resulted in 420,000 deaths globally and accounted for 33 million Disability Adjusted Life Years.¹ In addition, according to a study published in 2019 across all low- and middle-income countries (LMICs), lost productivity from premature death and disability resulting from foodborne illnesses and their treatment had a total economic cost of approximately USD 110 billion a year. Furthermore, the report stated that LMICs lose around US$15 billion a year due to the cost of treating foodborne illnesses.²

  [1] WHO, 2015b. Sugars Intake for Adults and Children. Guideline. World Health Organization, Geneva.
  [2] Jaffee, Steven; Henson, Spencer; Unnevehr, Laurian; Grace, Delia; Cassou, Emilie. 2019. The Safe Food Imperative: Accelerating Progress in Low- and Middle-Income Countries. Agriculture and Food Series, Washington, DC: World Bank.

• Pathway 4: Environmental contamination and degradation

  Another essential pathway includes the consequences of being exposed to contaminants in the water, soil and air. Although agricultural production models have evolved over time and nature-positive production including organic agriculture is on the rise in many countries agricultural production systems rely on the use of chemical fertilisers, pesticides and herbicides. As a result, labourers in the global food economy particularly in agricultural production are exposed to those substances both knowingly and unknowingly as those chemicals remain in soils, in water and in the air for a long time. In addition, the lack of enforcing health standards and/or the use of harmful materials puts labourers working in other segments of the supply chain at risk. Health impacts of environmental contamination and degradation through heavy metals, fertilisers, chemicals, microplastic, greenhouse gas emissions, air pollution and smog include the outbreak of communicable and non-communicable diseases, the rise of mental illnesses and leads to unintentional acute pesticide poisoning.

• Pathway 5: Occupational hazards

  Occupational hazards pose a major risk in food systems due to a higher risk of occupational injury and death in agriculture, fishing, and forestry than in any other sector with food manufacturing also presenting high rates of injuries and fatalities. In addition, industrial food processing and factory settings have been identified as highly stressful environments due to the pace of the production line, few work breaks, and other factors such as chronic ambient noise. Working in such an environment has been associated with a high risk to suffer from depression, exhaustion, concentration problems, insomnia, psychosomatic disorders and mental illness and an increased likelihood of committing suicide.¹ Ultimately production loss due to shortage of labour and productivity loss through reduced physical capacity threaten food availability affecting local/regional/national food baskets.

  [1] IPES-Food. 2017. Unravelling the Food–Health Nexus: Addressing practices, political economy, and power relations to build healthier food systems. The Global Alliance for the Future of Food and IPES-Food.

Impact of malfunctioning health systems on food systems

• According to estimations around 15% of waste generated by health-care activities is considered hazardous which includes infectious, toxic, carcinogen, flammable, corrosive, reactive, explosive or radioactive materials. All those materials have the potential to negatively affect occupational health trough air pollution, injuries, burns and toxic exposure to pharmaceutical products and spread of antimicrobial resistance.¹
• Health services are a key element of any health system and play an important role in detecting and treating malnutrition. If nutrition-related health services are not utilised there is a high risk of life-long suffering from the negative consequences of malnutrition. For instance, without regular checks after birth till the age of 2 in terms of weight and height malnutrition might not be detected resulting in life-long suffering from the consequences of stunting. In addition, non-attendance of antenatal care sessions contributes to low awareness on essential nutritional requirements during pregnancy and lactation potentially resulting in low birth weights as well as stunting of the child. Furthermore, low immunisation rates make it easy for illnesses to spread affecting physical health and the ability to work and to produce.

[1] Health-care waste